International H7N9 Assessment Team Completes Mission to China

A team of international and Chinese experts has completed its mission to visit Shanghai and Beijing and assess the avian influenza A(H7N9) situation, and to make recommendations to the National Health and Family Planning Commission (NHFPC).

"China's response has been exemplary," says Dr. Keiji Fukuda, the World Health Organization (WHO)'s assistant director-general for health security. "Government agencies such as the Chinese Center for Disease Control and Prevention (CDC) and local authorities of affected areas acted quickly, and have shared critical information such as genetic sequence and virus needed to analyze the situation and to be ready to make vaccine if needed in the future."

"The risks of such an outbreak situation are shared in a globalized world where we are all interconnected. This underlines the importance of the example set by China in following the International Health Regulations," Fukuda adds.

The team, which is jointly led by NHFPC and WHO, is comprised of international and Chinese experts in epidemiology, virology, clinical management, public health, and health policy. The purpose of the mission was to assess H7N9 situation and to provide recommendations.

During April 19-23, 2013 in China, the team met with those involved in the response, in both Beijing and Shanghai. In Beijing, the team met with staff from China CDC and Beijing CDC. In Shanghai, they met members of the city's H7N9 working group. They also met with the Shanghai Public Health Clinical Center, Shanghai Center for Disease Control and Prevention (CDC) and the Shanghai Center for Animal Disease Control and Prevention. The team visited a wholesale poultry market where they learned first hand about the effectiveness of the shut-down of these markets.

"China has experienced extraordinary diseases such as SARS and the 2009 influenza H1N1 Pandemic," says Dr. Liang Wannian, director general of the Office of Health Emergency at the NHFPC. "We are in new territory again with H7N9, but our experience has taught us how to face it."

The team noted the strong reporting systems and awareness in clinicians, municipal health and agricultural authorities in Shanghai, and the support offered by China CDC.

"The response reflects earlier and strong investments in health and preparedness made by China," says Fukuda.

The team estimates that steps taken so far, such as the suspension of live bird markets in Shanghai, were timely and sound. In Shanghai, it appears that so far poultry infections are limited to live markets. However, they cautioned that experts still have only a limited understanding of the full extent of the disease.

The elements that warrant particular concern include the fact that the virus does not seem to cause visible illness in poultry, making it harder to track and control.

Almost all cases have been sporadic cases, but a few family clusters have been identified. However, we are not sure if the clusters were caused by common exposure to a source of virus or due to limited person-to-person transmission. Evidence so far is not sufficient to conclude there is person-to-person transmission. Moreover, no sustained person-to-person transmission has been found.

The disease has now caused sporadic infections in more than 100 people, with the majority developing serious disease including more than 20 deaths. It is as yet unclear how many people might have carried the disease without showing any signs of illness. What also remains unclear is whether the virus could gain the ability to become transmissible between people.

The potential development of human-to-human spread cannot be ruled out, which is why this virus and outbreak is being taken extremely seriously and followed so closely.

In light of this, the team highlighted the need for continued cooperation at the national and international level. At the national level, there is a need for the health and agricultural sectors to continue working closely together. Internationally, the continued sharing of information, guidance, findings, and the viruses themselves is critical.